Urothelial tumors represent a spectrum of diseases with a range of prognoses. After a tumor is diagnosed anywhere within the urothelial tract, the patient remains at risk for developing a new lesion at a different location, or at the same location and with a similar or more advanced stage. Continued monitoring for recurrence is an essential part of management because most recurrences are superficial and can be treated endoscopically. Within each category of disease, more refined methods to determine prognosis and guide management, based on molecular staging, are under development with the goal of optimizing each patient's likelihood of cure and chance for organ preservation. For patients with more extensive disease, newer treatments typically involve combined modality approaches using recently developed surgical procedures, or 3-dimensional treatment planning for more precise delivery of radiation therapy. Although these are not appropriate in all cases, they offer the promise of an improved quality of life and prolonged survival. Finally, within the category of metastatic disease, several new agents have been identified that seem superior to those currently considered standard therapies. Experts believe, therefore, that the treatment of urothelial tumors will evolve rapidly over the next few years, with improved outcomes for patients at all stages of disease.
Available from: Brant A Inman
- "Due partly to this high recurrence rate requiring repeat surveillance and intervention, bladder cancer is the most expensive cancer to treat (on a per-patient basis) from diagnosis to death . While complete TURBT is the mainstay of therapy, treatment goals for NMIBC also include a focus on recurrence reduction and progression prevention . Adjuncts such as intravesical chemotherapy (IVC) and intravesical immunotherapy such as Bacillus Calmette Guerin (BCG) are frequently utilized in order to reduce the probability of disease recurrence. "
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ABSTRACT: Nonmuscle invasive bladder cancer remains a very costly cancer to manage because of high recurrence rates requiring long-term surveillance and treatment. Emerging evidence suggests that adjunct and concurrent use of hyperthermia with intravesical chemotherapy after transurethral resection of bladder tumor further reduces recurrence risk and progression to advanced disease. Hyperthermia has both direct and immune-mediated cytotoxic effect on tumor cells including tumor growth arrest and activation of antitumor immune system cells and pathways. Concurrent heat application also acts as a sensitizer to intravesical chemotherapy agents. As such the ability to deliver hyperthermia to the focus of tumor while minimizing damage to surrounding benign tissue is of utmost importance to optimize the benefit of hyperthermia treatment. Existing chemohyperthermia devices that allow for more localized heat delivery continue to pave the way in this effort. Current investigational methods involving heat-activated drug delivery selectively to tumor cells using temperature-sensitive liposomes also offer promising ways to improve chemohyperthermia efficacy in bladder cancer while minimizing toxicity to benign tissue. This will hopefully allow more widespread use of chemohyperthermia to all bladder cancer patients, including metastatic bladder cancer.
Available from: Geoffrey Keith Mitchell
- "Patients will be invited to participate if they are aged ≥ 18 years and have advanced cancer of any type. They must also have a Australian Karnofsky Performance Scale (AKPS) score ≥ 40, a fatigue score ≥ 4/10 by a single screening questionnaire adopted from the NCCN cancer-related fatigue guidelines,  a stable treatment regimen (including steroids) for at least 48 hours and likely to remain stable throughout the trial period, no planned treatment likely to influence fatigue during the trial, no change in thyroxine therapy or antidepressant therapy in the 3 weeks prior and an ability to understand all study requirements. Exclusion criteria are: unable to comprehend written English, confusion or mini-mental state examination (MMSE) < 24, unstable symptoms or disease such that the patient is unlikely to be able to complete all study requirements, history of severe ischaemic heart disease, uncontrolled cardiac arrhythmias or hypertension, electrolyte imbalances (Na, K, Mg, Ca) where attempt at correction is being considered, anaemia for which a blood transfusion is indicated, erythropoietin therapy in the previous 2 weeks. "
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It is estimated that 29% of deaths in Australia are caused by malignant disease each year and can be expected to increase with population ageing. In advanced cancer, the prevalence of fatigue is high at 70–90%, and can be related to the disease and/or the treatment. The negative impact of fatigue on function (physical, mental, social and spiritual) and quality of life is substantial for many palliative patients as well as their families/carers.
This paper describes the design of single patient trials (n-of-1 s or SPTs) of a psychostimulant, methylphenidate hydrochloride (MPH) (5 mg bd), compared to placebo as a treatment for fatigue, with a population estimate of the benefit by the aggregation of multiple SPTs. Forty patients who have advanced cancer will be enrolled through specialist palliative care services in Australia. Patients will complete up to 3 cycles of treatment. Each cycle is 6 days long and has 3 days treatment and 3 days placebo. The order of treatment and placebo is randomly allocated for each cycle. The primary outcome is a reduction in fatigue severity as measured by the Functional Assessment of Cancer Therapy-fatigue subscale (FACIT-F). Secondary outcomes include adverse events, quality of life, additional fatigue assessments, depression and Australian Karnovsky Performance Scale.
This study will provide high-level evidence using a novel methodological approach about the effectiveness of psychostimulants for cancer-related fatigue. If effective, the findings will guide clinical practice in reducing this prevalent condition to improve function and quality of life.
Australian New Zealand Clinical Trials Registry ACTRN12609000794202
Available from: PubMed Central
- "After surgery for primary tumor, adjuvant chemotherapy was administered according to the guidelines of National Comprehensive National Comprehensive Cancer Network, unless pathologic stage was T2 or less and there was no nodal involvement or lymphovascular invasion. Palliative chemotherapy was administered when there was evidence of disease progression like distant metastasis or unresectable loco-regional recurrence . Regimens for adjuvant chemotherapy were generally 3 cycles of gemcitabine and cisplatin (GP). "
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ABSTRACT: Treatment of pulmonary metastasis from urothelial cell carcinoma has been mostly palliative chemotherapy and the role of pulmonary metastasectomy has not been investigated much.
This study is a retrospective interim review of pulmonary metastasectomy from urothelial carcinoma at single institution between 1998 and 2010. Overall 16 patients underwent pulmonary metastasectomies.
There was no postoperative complication or hospital mortality. Mean hospital stay was 6 days. Overall and disease-free 5-year survival were 65.3% and 37.5%, respectively.
In selected patients with pulmonary metastasis from urothelial carcinoma, surgical treatment is feasible and could contribute to long-term survival in selected patients.
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